Readers Write: ICD-10 is a Win for Patients

ICD-10 is a Win for Patients
By Ken Bradberry

There has been conversation about how the ICD-10 transition will impact unsuspecting patients. Maybe a procedure is delayed due to an inaccurate code or a bill is incorrect. These things will almost certainly happen. While the first days have gone by without significant disruption, it is inevitable that bumps will occur, as with any major technological implementation.

The real story is how much patients have to gain from the transition. ICD-9 was over 30 years old and didn’t keep pace with the dramatic advancements in the healthcare industry. Consider this short list of examples:

• Laser and laparoscopic surgeries were not performed at the time ICD-9 was implemented, but are common medical techniques today.
• Treating a heart attack 30 years ago was generally limited to medications to treat pain and an irregular heartbeat. Today, doctors can quickly evaluate what is causing the attack and treat accordingly – bust clots with new drugs, insert a stent to prop open a narrowed vessel, even sew new vessels into the heart during surgery.
• The first HPV vaccine approved by the FDA in 2006 has significant potential to prevent cervical cancer and is widely recommended by the Centers for Disease Control and Prevention for girls and young women.

This is just the tip of the iceberg in terms of how far medical advancements have come in the last 30 years. There has also been significant change in our health with newly discovered medical conditions and the rate at which diseases are diagnosed. For example, the CDC reports melanoma rates have doubled over the past 30 years, but chickenpox cases in the United States have dropped sharply since the vaccine became available in 1995.

Clearly the healthcare landscape today is almost unrecognizable from where it was 30 years ago. Patients have different healthcare concerns and conditions and have many more options for prevention and treatment.

ICD-10 has about five times as many codes as ICD-9. The codes are much more specific in describing a diagnosis and treatment plan, allowing for providers and payers to have a more detailed and accurate conversation about a patient’s care. This will not only improve accuracy of statements and bills received by a patient, but also improve health safety and outcomes.

Here is an example of ways a patient may benefit from ICD-10 throughout the healthcare experience:

• Diagnosis. During a routine medical exam, a spot is detected on a patient’s lung that requires additional investigation. The healthcare provider orders a series of procedures that require ICD-10 coding to be completed. Because ICD-10 codes are more granular, scheduling the procedure with the right resources is more likely, and therefore a more accurate and timely diagnosis is possible. The precision offered by ICD-10 will not only lead to a more precise diagnosis, it will also provide the provider with more insightful information to guide treatment plans.
• Eligibility determination. This same patient has health insurance which requires testing, procedures, and treatment to be authorized. The ICD-10 codes provide the payer more specific information on the services being provided, which can result in a timelier eligibility determination. This can avoid unplanned cost to the patient and frustration working through a billing issue.
• Quality outcomes. Improved clinical documentation under ICD-10 will help reduce medical errors and also lead to more meaningful discharge data that can help reduce readmissions.

In order to quickly navigate the hiccups caused by the massive transition and quickly get to the point where patients are experiencing real benefits, it’s critical for all stakeholders involved in the delivery of care to choose a partner who can successfully lead them through the complexity of ICD-10.

Ken Bradberry is chief technology officer of Xerox Commercial Healthcare.

Readers Write: The Benefit of Price Discrimination

The Benefit of Price Discrimination
By James Foster

In his Monday Morning Update for 10/12/15, Mr. HIStalk first affirmed the effectiveness of the market in selecting among EHR vendors. Later, in response to a price survey, he expressed frustration with disparate costs of services, saying, "I still don’t understand why providers shouldn’t be required to offer their lowest prices to everybody." His complaint here is with what economists call "price discrimination.”

There are two general justifications for price discrimination: (1) differences in costs to the seller and (2) differences in value to the buyer. Cost differences may explain things like quantity discounts, since even if the widgets cost the same to produce, the marketing and sales costs are less if the seller has to deal with fewer buyers.

Even with the same quantity of what seems to be an identical product or service, there may be hidden costs that can justify a difference in price. For example, the price for a television purchased on credit in a poor neighborhood may be much higher than the price for the same model paid for in cash at a suburban Costco. Here the product is not just the electronics, but also the transaction costs involved in offering credit to poor-risk buyers.

Differences in value to the buyer are no less real and can be justified as a way to ensure that the goods are available at all. Most of us are familiar with the fact that adjacent passengers on the same flight can pay very different prices for the trip. On the one hand, this seems unfair ("I still don’t understand why providers shouldn’t be required to offer their lowest prices to everybody"). On the other hand, it is often the case that if everyone were charged the same price, the product or service could not be supplied at all.

That is, if the airline ticket prices were uniformly high, fewer people would make the purchase and the total revenue would not be sufficient to cover total cost. Likewise, if prices were uniformly low, the planes would be full (aren’t they already?) but the total revenue still would not be sufficient to cover total cost.

In order to provide air travel, airlines must segregate buyers into those that place lower value on the trip (vacationers who could drive or choose a different destination) and those that place a higher value on the trip (business travelers). This discrimination serves to benefit travelers who would not make the trip unless they still have some value over the price.

Healthcare providers face similar challenges as airlines: capital costs are high and marginal costs are low. Yet charging everyone the same (high or low) price would not yield enough revenue to pay for the equipment and staff. Therefore, quantity discounts are offered to large groups (represented by credit-worthy insurance plans) who can take their business across town, while unknown individuals who buy on credit typically face higher prices.

If this still seems unfair, before calling for more government regulation through price controls, we should investigate how government regulation might be contributing to problem. There are a few areas in healthcare where prices are standard, published, and declining over time, such as Lasik eye surgery. These typically are procedures where the consumer is responsible for the full price of the service and takes time to investigate before making a purchase.

Instead of imposing price controls (which have been disastrous in a variety of industries), we should look for policy changes that encouraged more consumer involvement and responsibility.

James Foster is director of operations for GemTalk Systems of Beaverton, OR.

Readers Write: No One Likes the Waiting Game

No One Likes the Waiting Game
By Janie Tremlett

No one likes waiting in line with seemingly no information about when the wait will end, especially when sick or nervous about seeing a doctor. The frustration doesn’t end when you’re called out of the waiting room. Need to get vital signs captured? X-rays taken? Blood drawn? Most likely each of these steps occur in different locations and with different practitioners.

Confusion on the part of the patients about where to go and who to see, combined with staff confusion about where the patient is in the process, can make for a less than optimal experience for both the staff and the patients. In an age where providers’ revenue is contingent upon their patient satisfaction scores, managing patient flow and delivering a superior patient experience is more important than ever. A few ideas …

Intelligent Patient Queuing

Average wait times by provider or facility can be displayed on queuing display monitors and can be updated dynamically when a patient is called off the queue. For added convenience, patients can be summoned off the queue in method that is preferred by them, whether it be via an SMS text, an email, or a phone call. They don’t have to be tethered to a waiting room chair waiting for their names to be called. Instead, they can grab a bite to eat in the hospital cafeteria or take care of any other issues.

Patient and Family Preferences

It sounds simple, but it cannot be emphasized enough: patient demographics need to be understood. Patients in waiting rooms are often anxious and sometimes frustrated if they’ve been waiting there a while. Giving them a way to keep busy while they wait, over and above the typical waiting room magazines, can go far. Providing toys and games to children in a pediatric waiting room setting makes sense, but how many waiting rooms have you been in that provide Wi-Fi for adults? Likewise, offering entertainment infotainment that is pertinent to a certain demographic — like screening live athletic games in a sports medicine office — would resonate with patients.

Patient Communications

We can expect, if you haven’t seen it already, a significant expansion in regards to mobile communication within healthcare. One of the benefits of this expansion is the new ease it brings in communicating with patients. Providers can send reminders about appointment dates and times to patients via SMS as well as give patients insight into expected wait times pre- and during service. Affording patients the ability to communicate to their providers in this same way is key. When a patient can easily and conveniently communicate any delays or early arrivals he or she is experiencing, the hospital staff can then re-route that patient or other patients to accommodate the change in schedule.

Real-Time Dashboards

With real-time reporting and dashboards, staff can track a patient’s whereabouts and status at any point as well as the time spent in each location. With this information, hospitals and other providers can identify any breakdowns in processes or bottlenecks in certain departments so adjustments can be made quickly. If patients routinely spend too much time waiting to get their blood drawn, staff can be reassigned to the lab so more patients can be seen. Likewise, if a patient is waiting to see the doctor but the doctor is running late, the patient can be directed to the lab to get blood work done if there is availability there.

Way-Finding and Patient Tracking

Way-finding, real-time location systems (RTLS) technologies, and Bluetooth beacon technologies are rapidly becoming part of hospital IT infrastructure. Within the hospital, geo-location services hold great promise for patient flow management, such as being able to guide a patient to locations relevant to their appointment, track assets (such as key equipment used to move or discharge patients), and monitor staff actions, such as time spent with patients and how often a patient was seen.

Patient tracking also enables context-specific messaging for visitors, like targeted health promotion campaigns based on a patient’s specific movements and location. For example, offering reminders to patients to get their annual eye exams as they walk by the eye clinic in a hospital.

Early implementations of way-finding and patient tracking solutions have not married patients’ whereabouts to staff workflow. Tethering these two is helpful so staff can mitigate problems and issues as they arise and where they arise. If staff realize they’re running behind, for example, and a patient happens to be waiting in the hospital cafeteria, the staff could capitalize on their knowledge of the patient’s location and send the patient a voucher for a free coffee or something similar to enjoy during their wait.

Pleasing patients isn’t always easy, but ensuring that they move through their hospital or provider’s office quickly and efficiently can help satisfy them. Leveraging patient self-service, intelligent workflows, and reporting can create an information-rich tool for staff to monitor patient flow and an empowering experience for patients.

Janie Tremlett is GM of patient solutions at Vecna Technologies of Cambridge, MA.

Readers Write: The Patient Perspective (aka, Who Just Knocked the Floor Out from Under My Feet?)

The Patient Perspective (aka, Who Just Knocked the Floor Out from Under My Feet?)
By Teri Thomas

On the plane back from a short vacation in the Caribbean, my throat and head began to ache. It worsened until I suspected strep throat. 

After waiting 30 minutes (in a room with other ill people) at the nearest urgent care, I was curtly informed that my insurance no longer covered my care there. Miserably, I drove to the next closest urgent care while I called my insurance company for guidance. They directed me to their web site and asked me for names of individual physicians. However, I just wanted the nearest place to get a strep test. 

I pulled into the next urgent care lot and gave my insurance company their address. Not covered. Third choice was covered, so I waited in the queue and eventually was swabbed. After an hour or so, they informed me it was negative and sent me home with “Tylenol and rest.” I felt a little ashamed to have wasted their time and resolved to toughen up.

Two days later, my sore throat had worsened. I was spiking fevers over 102 and my headache became the worst in my life. My body ached and shook and the pain made light and normal sounds hard to tolerate. I held my head in my hands while my husband drove me to the ER.

The ER nurse gave me a medication. When I asked her what I it was, she said, “la-la.” I found it strange (I had no idea what la-la was), but since it hurt to talk, I let it be. Then the doctor came in and asked me what pain medication I was given. I was embarrassed — all I knew was that the nurse called it la-la. Strangely, he seemed OK with that and he didn’t choose to clarify or comment (it was Dilaudid). They drew blood and did a spinal tap, suspecting meningitis. Things began to move around me, giving me the feeling of being an object instead of a person.

They admitted me to the hospital, bundling me in blankets for chills and medicating the pain, while trying to figure out what my illness was. Each doctor gave me a different diagnosis, often confidently. The epidemiologist said, “It’s dengue.” I had chest x-rays and was told pneumonia. The next doctor said I did not have pneumonia. 

My husband and I wanted the doctors to talk with each other. It didn’t appear that they did, as my husband or I had to inform each doctor about what the others had said. The neurologist asked me questions, but never shared his conclusions. I had to painfully recount the course of my illness to him and the others.

Respiratory therapy was a lifeline because they stayed in the room enough for me to be sure I knew who they were. A curious thing to me was the feeling that I existed “in part” to the various specialists. I was a CNS, or pair of lungs, or a Caribbean vacation. 

Some of the doctors seemed to go as fast as they could in their questions. I felt like a speed bump in their race to their next (maybe more important?) patient. As a patient taking pain medication, it was difficult for me to keep up with them, and since I didn’t have time to prepare for a new visitor (they were a surprise), I gave regretfully jumbled and incomplete information. 

After explaining my history and situation for the third time, I hand wrote the timing, sequence of events, and main symptoms on a piece of paper for new physicians or providers to read. It seemed strange that they didn’t seem to want to read it.

It meant a lot to have someone look me in the eyes.

My attending was a foreign-born hospitalist who directed his dialogue to my husband as if I weren’t there. Being a fairly assertive person, I asked him to please include me. With his mouth, he said, "What can I do for you?" yet his eyes and body language said, "You are wasting my time." 

After being denied by nursing, I asked him for the results of my labs and he said he couldn’t do that. He then asked which ones specifically, and only then verbally answered for those specific tests I could think of the top of my head. A printout or online access would have been much better. Not getting information about my own body was incredibly frustrating. It felt disrespectful, as this was happening to ME.

There was a big sign directly in front of my bed that said, "Medications, always ask– explanation, dosage, side effects." Not once did a doctor or nurse ever offer side effects or dosage information. During times of decent pain control, I found the sign humorous.

In writing this, I struggled to find the best word to sum up how the admission felt. Words that come to mind include humiliating, confusing, and castrating (in the sense of taking away one’s strength). I was a strong, educated, independent woman, used to being on top of things (and directing others) with a solid understanding of healthcare, medical terminology, and hospital operations. Suddenly, I had no control over my schedule, no idea who or what was coming next, was highly vulnerable due to pain and pain medications, and I was afraid — something painful and strange was going on in my body. 

My toilet was set with a plastic catcher to measure my urination, but it sat there overflowing because nobody emptied it. There was a white board in my room with some basic information (e.g. name of my nurse), but it was often incorrect. The pain meds made it hard to track what was going on, yet I seemed to be the owner of communicating my situation to all of the changing players around me. I started taking my own notes in a notebook to ensure I was telling people the correct medications. 

The alarms, blood pressure cuff squeezes, and noise outside my room meant I slept fitfully at best. When I did sleep, I had intense nightmares that caused me to wake in an utter panic. Maybe from my mystery illness, maybe from the medications. Either way, it was intense, and I was grabbing for any sense of control or understanding that I could. 

I was reaching for blocks of reassurances (seeing my labs directly, seeing my problem list or diagnosis notes, being told what or who was coming up and when). Simply hearing my care team collaborate and come to me informed and with a unified hypothesis would have made an enormous difference.

Eventually my blood work showed I was stabilizing. The pain began to subside enough that I — knowing the risks of hospital-acquired infections — asked to go home and recover there. I was told a few weeks after discharge that two blood tests were negative for dengue fever, so I never did find out a definitive diagnosis. I got a copy of my H&P and discharge summary and found it humorous to see how little useful information was included, yet there were numerous references to how pleasant I was (surprising, as I was in terrible pain and struggling to be pleasant, but also not very relevant). 

It certainly could have gone better, and I’m sure for some patients, it does. I can almost hear the comments, “My patients don’t want their lab information; it would just confuse them.” Fair enough. Each patient is different. However what they have in common is a desire to feel respected and listened to. 

If folks are interested, I’m happy to post what happened after that—the experience with post-hospital care coordination, billing, how this relates to HCHAPS, as well as concrete suggestions and lessons learned. Do let me know. Having worked in healthcare for 25 years, this experience has energized me to continue to try to make things better. 

Teri Thomas is vice president of Epic Systems of Verona, Wi.

Morning Headlines 10/21/15

IBM Reports 2015 Third-Quarter Results

IBM reports Q3 results: total revenue was $19.3 billion, down one percent from 2014, EPS $3.34 vs. $3.68. Q3 marks IBM’s 14 straight quarter in which revenue fell. Stock price dropped 5.7 percent on the news.

KLAS publishes inaugural interoperability study

KLAS publishes its first interoperability report, concluding that private vendor HIEs are the best value-to-effort interoperability option, and reporting that Athenahealth is the easiest system to connect with, followed by Epic and Cerner.

UCHealth-Aspen hospital partnership improves record system

11-bed Aspen Valley Hospital (CO) will partner with the University of Colorado Health to implement Epic within its facility.

Jack Adcock death: Accused doctor ‘called off resuscitation’

In England, a doctor at Leicester Royal Infirmary is fighting manslaughter charges after missing abnormal lab results for a pediatric patient in part because the hospital’s computers system had failed. As the patient deteriorated a Code Blue was called, which the doctor halted because he mistakenly believed there was a DNR order in place.

Curbside Consult with Dr. Jayne 10/20/15

I wrote last week about interoperability, mentioning that attempting to connect through Direct has added confusion for providers like me who have multiple practice situations or multiple locations. A reader commented, “vs. how many fax numbers to create an out-of-paper trail with?”

That’s a very good question. It points to a larger problem with EHRs – one that most if not all providers complain about – which is the shifting of work from staff to providers.

Sometimes this is in the name of efficiency. Why have the patient wait for the referral to be entered when the provider can just do it at the point of care? Why have the provider have to tell a staffer when he or she can do it real time?

In many cases, this is a misguided attempt at efficiency. Although we can reduce the number of steps in a process, that’s not everything we look at when we map workflows. We also need to look at the cost of various people doing various tasks. It often doesn’t make sense for providers to do certain steps that EHR workflows are trying to force them to do.

Other times this is in the name of patient safety. In its purest form, this makes sense. Having providers enter medication and laboratory and diagnostic orders can prevent transcription errors and allow them to acknowledge warnings and alerts. It’s a good use of some of the most expensive employee hours in the office. Unfortunately, that thinking has driven a lot of work upstream that organizations haven’t yet redistributed to where it is most appropriate.

In the paper world, my referral process involved a single page flow sheet where I marked what to send in the referral bundle and who to send it to, along with a diagnosis. My medical assistant knew the short list of common referrals and where to send the packet. They managed that list of fax numbers and locations, not me. They knew whether to send the packet to the West Office for a Thursday appointment or to the South Office for anything else.

Now that the referral workflow has been embedded into the provider workflow in my EHR, I’m supposed to manage those facts while I’m sitting in the room with the patient, because they system wants me to complete it before I move on.

Of course, I could simply send an electronic task to my staff and ask them to do it, but that takes me out of my standard workflow as well. Don’t get me wrong, I’m excited about the ability to exchange secure messages with consultants and colleagues and have a copy added to the chart automatically, preventing phone tag and manual note-writing. But if it’s too complicated to find my key providers, I’m going to struggle.

Two of the three systems I use on a regular basis have no way for the physician user to create their own address book or contacts list outside of the practice. One has a robust partial search where I can search a metropolitan area for a given physician. The other requires me to know the specific postal city associated with my target’s ZIP code. Honestly, I need to just search for Dr. X who is a cardiologist in the Chicago area. I have no idea whether they’re in Oak Park or Oak Brook and neither does my patient.

These are usability issues as well as workflow issues. I can’t help but think that if vendors did more trialing of product with real-world physicians they would be better able to identify these things up front. We know from recent publications that vendors vary widely in how they perform usability testing (if at all) and how valid the results might be.

I’ve been on some usability focus groups as a participant and it’s hard to manage bias and dominant behavior by some members. I’ve also supported usability testing for vendors and know that it’s hard to find knowledgeable participants who are willing to take time out of their busy schedules to participate in a usability study unless you throw ridiculous amounts of money at them. Even then the output varies widely.

There are also physician psychology issues at play when work gets redistributed. Physicians realize how lean their offices run and can be reluctant to shift work to staff members that are struggling to get out of the office on time to pick up their children or tend to other obligations. Employers may be unwilling to pay overtime or to approve the hours needed to actually do the work, so someone has to take care of it and often that is the provider. There is also a perception that it’s quicker to just do the work yourself rather than ask someone else to do it. Couple this with a lack of time and energy to do the actual process improvement work needed to fix the underlying workflow issues and it’s a recipe for dissatisfaction all around.

I’m working with a practice this week that has engaged me to do some workflow re-engineering, so this is in the center of my thoughts. I’ve worked with them before and the issues are complex. They only took about 20 percent of my advice last time, and although they initially made progress, ICD-10 and two software upgrades have caused some chaos.

They’re one of the last independent practices in their community and does a mix of traditional primary care and somewhat fringe (read: cash only) services. The owner doesn’t really have a head for where primary care has been going in the last few years and I’m not sure he’s committed to doing what needs to be done to be successful. Frankly they’d be better off transitioning to a retainer or concierge-type practice, but they don’t want to do that either.

It’s shaping up to be an interesting week and I can guarantee no boredom or downtime as I dig in with these folks. Not to mention they’re in one of the best cities in the US for barbecue, so I have nothing to complain about for dining choices this week.

What’s your favorite BBQ locale? Email me.

Email Dr. Jayne.

News 10/21/15

Top News

KLAS rather histrionically reports (placing itself prominently in the story) that vendor CEOs and provider CIOS will “lock arms to make a difference” in supposedly agreeing to unstated objective measures of interoperability as John Halamka reported on his blog October 6. They will then “work closely with Washington to help alleviate the interoperability measurement burden faced by the government.” The obvious problem is that technical standards reflect capability, not reality, and the ultimate test of interoperability is best assessed by patients trying to get all of their providers working from the same basic information. It matters little that a provider’s EHR scores high on interoperability if it isn’t willing or able to share information.

Reader Comments

From Stewart Scrooged: “Re: Ministry Health Care. CEO announces that 500 employees will be RIF’d in what he calls ‘future-sizing.’ Last day for the chosen ones will be 11/28/15. Merry Christmas!” Unverified.  Any organization that lays off employees in November or December is desperate, incompetent, or cold. The best thing about layoffs is that while companies jettison their least-valued employees, their best ones get the message and start looking elsewhere, closing the karmic loop.

From Lab Matters: “Re: Jeb Bush’s health plan overhaul. This is not a repeal and replace proposal. This tinkers on the edges of the ACA. And, not to be cynical, but wouldn’t the reduction in the barriers to entry really benefit his cousin Jonathan? He’s another phony crony wanting more giveaways to the private sector at the expense of the public good. Is the ACA perfect? Not by any means. But fix it. Stop with the ‘repeal’ madness that will go nowhere. Playing to his base by saying that is what he is doing and then NOT actually doing it is disingenuous at best. Sorry, Jonathan. Maybe you are the smart Bush people keep referring to since clearly isn’t Jeb.” Jeb Bush’s health plan says Obamacare has made a messed up health system even worse as the federal government took over one-sixth of the country’s economy, concluding that  it “embodies the liberal idea that Washington needs to and can solve every problem,” hurting middle-income families in the process as premiums increase and healthcare choices decrease. Bush’s health IT proposals involve eliminating the Meaningful Use program and associated penalties and publicly releasing all raw, de-identified Medicare and Medicaid claims data. I agree with a lot of what he suggests, although I think his emphasis on innovation as a solution is probably misplaced, repealing the ACA is unlikely, and the idea that all of America  (including Fortune 100 companies, medical associations, pharma, and their cadre of lobbyists) will obediently line up and scrap a system that made them rich is naive. His main focus seems to be letting the states run healthcare, which isn’t how it was done in those many countries whose citizens enjoy better and cheaper care than we do.

From Pilsner: “Re: Peer60 EHR report. It does not meet the basics to be called credible. Could you please ask for and publish the N value and demographic information?” The report did not cover EHRs in general – it specifically looked at ambulatory “organizations” that are either hospital-owned or independent. It was what Peer60 calls a “First Reaction” report that collects and publishes information quickly rather than exhaustively, which in this case involved 184 respondents, according to the company. It should be noted that Pilsner has a vested interest in Meditech and therefore in questioning the Meditech-unfriendly survey results.

From Follicular Folly: “Re: Cardinal Health. I was bidding for a health IT services contract and was required to take a hair follicle drug test through DC-based Metro Labs. The location was in a tiny hall, the office was beat up, and supplies were thrown all over the shelves as the entire staff conversed in Ethiopian. They said the hair had to be three inches long, and without warning, the manager chopped off two handfuls worth! I reported this to Cardinal Health, who asked what they could do, and I gave them some requests. They removed me from consideration because they couldn’t accommodate those requests. Now I have a chunk of hair missing and can’t get work .” The Yelp reviews for Metro Labs are mostly scathing.

From Mineopie: “Re: Catholic Health Initiatives. Recently entered into a managed services agreement with both Cerner (inpatient EHR) and Allscripts (outpatient EHR), just announced same for Deloitte AMS to manage Epic markets.” CHI announced the Cerner contract in July 2015 and an Allscripts hosting agreement in November 2014. They’ve been working for years with Deloitte, which announced earlier this year that it would turn its CHI Epic work into a service called Evergreen.

From Bilge Water: “Re: tweets. Your social media posts on Facebook and Twitter get good attention from companies. Nice!” Correction – they sometimes get the attention of twenty-something marketing assistants who are assigned the task of making companies look hipper than they really are by tweeting and Facebook posting on their carefully controlling behalf. It’s not as though any big company’s CEO has actually seen what goes out under the company’s Twitter and Facebook accounts, much less that he or she is writing it personally or retweeting it. It’s easy to forget in a Twitter-induced fog of pedantic kindred spirits that that most of the world, including a high proportion of business executives, has zero interest in what’s on Twitter because it’s just people talking to themselves hoping desperately that someone else is listening.

From Yukon Gold: “Re: Medicare Part A hold for outpatient claims due to Local Coverage Determinations needing to be updated in their system. They are targeting an October 23 turnaround, but this is exactly what hospitals worried about — the federal government NOT being ready for ICD-10.  This is a big deal for anyone without large cash reserves that has a payer mix that isn’t mostly commercial.” Unverified.

HIStalk Announcements and Requests

Just over half of poll respondents are interested in Meaningful Use news, while the almost-half that includes me has grown weary of the topic. New poll to your right or here: have you ever been sexually harassed at work? I’ll trust your own definition.

Thanks to Jenn for covering the last couple of posts for me. You will agree with me that she did her job well if you didn’t notice anything different.

I’ve been following the Theranos drama, happy that I had long ago already covered all of the now-hot questions about the company in previous HIStalk posts — that only one of its tests is FDA approved, that its microfluidic methods haven’t been independently validated against traditional ones and make up a minority of its tests, and that the still-small company seems secretive and has a weird but high-powered board. Here’s the thing, though – the microfluidic and nanotainer stuff makes the company sexy to Silicon Valley types and hypes its potential valuation as a technology play, but its real innovation is rock-bottom lab test pricing. Patients will get lab work done no matter how their blood is drawn even though they might prefer the Theranos-exclusive finger stick. Investors might like the company less than before, but patients should be happy that Theranos is trying to break the oligopoly of big lab companies and hospital labs whose technology allows them to process most tests for nearly no incremental cost while charging high prices. Theranos is lucky it isn’t publicly traded yet since the stock would otherwise be tanking on the barrage of criticism.

Ms. L says her Indiana kindergartners love using the two Kindle Fires we bought via the DonorsChoose project, enjoying small-group Kindle Station time every day for practicing letters, numbers, and shapes. I have a few weeks left to use the matching funds generously provided by an anonymous vendor executive for donations of $100 or more. Companies or individuals can follow these steps:

1. Purchase a gift card in the amount you’d like to donate.
2. Send the gift card by the email option to mr_histalk@histalk.com (that’s my DonorsChoose account).
3. I’ll be notified of your donation and you can print your own receipt for tax purposes.
4. I’ll pool the money, apply the matching funds, and publicly report here (as I always do) which projects I funded, with an emphasis on STEM-related projects as the matching funds donor prefers.

Here’s another DonorsChoose photo I received from Ms. Klotz, whose Illinois kindergarten class received math learning centers from us. She says the students love hands-on math work in practicing measurement, geometry, number operations.

Webinars

None in the next few days. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Former HBOC Chairman Charlie McCall has been paying an army of lawyers for years in trying to have his 2009 criminal conviction for securities fraud and his 10-year prison sentence overturned. He failed again this week as the US Supreme Court rejects his argument that his legal counsel was ineffective.

IBM announces Q3 results: revenue down 1 percent, adjusted EPS $3.34 vs. $3.68, with its sexy product lines like Watson, cloud computing, and mobile computing failing to stop the bleeding. Revenue fell for the 14th straight quarter, missing analyst expectations and sending shares down sharply on Monday. Above is the five-year share price of IBM (blue, down 2 percent) vs. the Dow (red, up 55 percent).

MMRGlobal, a self-proclaimed personal health records vendor whose business focus instead is filing patent infringement lawsuits, will conduct a one-for-five reverse stock split in hoping to strike deals with health IT firms (presumably to buy vague, dormant patents to keep their suit-filing lawyers busy). Maybe they should have gone 1,000-to-one since the OTC market shares are trading at $0.0038, valuing the company at $3 million (the price is so low that the major markets just report it as zero). Both share price and revenue are down 70 percent in the past year and cash flow is negative. Bob Lorsch owns 46 million shares, which sounds like a lot until the calculator shows their value as $175,000.

The Right Place, which connects hospitals with nursing homes for patient placement, raises $2 million.

India-based Attune, which offers a hospital information system and medical device integration, raises $10 million in Series B funding from Qualcomm Ventures and Norwest Venture Partners.

Welltok acquires children’s health gamification platform Zamzee from HopeLab, a non-profit started by eBay founder Pierre Omidyar.

Payments and EDI vendor InMediata raises $4 million

Healthcare API vendor Redox raises $3.5 million. 

Sales

West Georgia Health (GA)  chooses Agilum Healthcare Intelligence. 

Cooper University Health Care (NJ) selects eHealth Technologies for record aggregation and analytics.

Baptist Health Care (FL) chooses Allscripts products Sunrise, Sunrise Revenue Cycle Management, EPSi, FollowMyHealth, and dbMotion, beating out Cerner and Epic. Baptist was running McKesson Horizon for inpatient and NextGen for outpatient.

Hartford HealthCare (CT) will implement Glytec’s eGlycemic Management System in its five hospitals.

People

Cynthia Kilroy (Optum) joins Huron Consulting Group as managing director.

Announcements and Implementations

In England, a doctor on trial for killing a six-year-old boy by ordering a Code Blue team to stop trying to save him after confusing him with another patient who had a DNR order admits that she also missed abnormal blood test results that were read to her over the telephone during hospital computer system downtime.

New Zealand announces plans to implement a single national EHR over the next 3-5 years.

Johns Hopkins University School of Medicine and Microsoft will work together on technology that will collect ICU monitor data to highlight big-picture trends for a given patient. They will revise Project Emerge, a Hopkins ICU redesign project that integrates ICU monitoring data via a tablet app.

Aspen Valley Hospital (CO) will implement Epic with the help of University of Colorado Health. The announcement says the implementation will give UCHealth “expanded opportunities for clinical collaboration with the goal of keeping care close to home,” which sounds a lot like using Epic to lock in referrals.

Beaumont Hospital – Farmington Hills (MI) — the former Botsford Hospital — goes live with Epic. They previously ran McKesson Paragon.

Summit Healthcare announces that four hospitals have implemented its Scripting Toolkit – Wellspan Health, Halifax Health, Nathan Littauer Hospital, and Phoebe Putney Health System. Also announced were upcoming upgrades to the product.

Qpid Health announces GA of Qpid Groupers for Epic, a subscription service of clinical content uploaded via an Epic-provided import tool. 

Privacy and Security

Apple removes several hundred apps from its App Store that were found to be using technology developed by a China-based advertising company that collects user information to push targeted ads.

Other

A New York healthcare staffing agency apologizes for running a nurse employment ad in the local Pennysaver that specified, “no Haitians.”

ZDoggMD has turned out some impressive music videos, but now he’s pimped himself out as an Athenahealth spokesperson and is making commercials rather than art. His new one incorrectly blames EHR vendors rather than regulators and bill-payers for the computer work he and his peers are required to perform as a condition of being well compensated, which is like complaining that TurboTax is terrible because it involves paying taxes. He also fails to mention that the employer of those providers (or they themselves) purchased those EHRs voluntarily. Given the functionality requirements of the typical hospital or practice, an innovatively designed new product would look quite a bit like the old ones, excessive clicks and all. We’re the only profession in which the highest-paid workers are expected to peck on computers all day – you would dump your attorney or accountant in a heartbeat if they wasted their expensive time typing while you’re talking. You may also correctly assume that the top-ranking executives of health systems and health IT vendors rarely sit at a keyboard despite their evangelism of the idea for everybody but themselves.

A KLAS interoperability study of minimally described methodology finds that Athenahealth’s EHR is easiest to connect to, followed by Cerner and Epic. That conclusion is pretty much negated by the admission by both vendors and providers that the technology isn’t the problem with lack of interoperability – it’s lack of agreement on standards and the willingness to actually share information.

More drug pricing nonsense and unintended consequences: Congress requires FDA to issue “priority review vouchers” as a reward to companies that develop a drug for underfunded diseases.The vouchers guarantee that FDA will review their next drug in six months instead of its usual 10 months. Drug companies are selling their FDA-issued vouchers on the secondary market, with AbbVie recently buying one from another drug company for $350 million just to cut the FDA’s bureaucratic review time by four months. You can bet that whatever drug they’re developing will be expensive if getting it on the market a few weeks earlier is worth that kind of money.

A study finds the obvious – large health systems are buying up physician practices and then jacking up their prices in using their consumer brand recognition clout to force insurance companies to pay more. What’s unknown is whether those notoriously inefficient health systems will fare better than they did in the 1990s, when they bought a lot of practices only to be shocked by the resulting drop-off in physician productivity.

Weird News Andy says, “I’m not dead yet … well …” in describing a man in India who wakes up as his autopsy begins, only to die later in the ICU.

Sponsor Updates

• Direct Consulting Associates and HDS will exhibit at the Midwest 2015 Fall Technology Conference October 25-27 in Detroit.
• Divurgent and Cerner Health Conference attendees raise $2,000 for Children’s Mercy Hospital (MO).
• Caradigm posts an infographic on clinically integrated networks.
• EClinicalWorks recaps its user conference in a series of posts.
• Clinical Computer Systems posts an integration video for its Obix perinatal database system.
• Extension Healthcare will exhibit at the 2015 CALNOC Conference October 26-27 in Long Beach, CA.
• Healthwise will exhibit at the HealthTrio 2015 Users Group Conference October 26-28 in Tucson, AZ.
• Aprima will exhibit at the AAP Experience National Conference & Exhibition October 24-27 in Washington, DC.
• Aventura and Crossings Healthcare Solutions will exhibit at the 8th Annual Regional DV-NJ Chapters HIMSS Conference October 28-30 in Atlantic City, NJ.
• Bernoulli releases a new case study featuring Hospital for Special Care, “Achieving Clinical Clarity from Ventilator Overload.”
• Forward Health Group will sponsor the American Heart Association’s Heart Innovation Forum in Chicago on October 29.
• CapsuleTech will exhibit at Anesthesiology 2015 October 24-28 in San Diego.
• Impact Advisors publishes a white paper titled “Summary and Analysis of the MU Final Rule: Modifications in 2015-18 and Stage 3 Requirements.”
• Caradigm and CoverMyMeds will exhibit at the Midwest 2015 Fall Technology Conference October 25-27 in Detroit.
• CareTech Solutions launches a new video series, “Women in IT.”
• CenterX CEO Joe Reinardy will speak at the 2015 Real-Time Benefit Verification & ePrior Authorization Forum October 22-23 in San Francisco.
• CitiusTech will exhibit at IBM Insight 2015 October 25-29 in Las Vegas.
• Craneware and its client Parkview Health (OH) will present “Enterprise Pharmacy and Supply Chain Revenue Integrity’ at HFMA’s MAP Event on October 26 in Fort Lauderdale, FL.

Blog Posts

• Galen Healthcare Solutions is THE Best Place to Work (Galen Healthcare Solutions)
• Orthopedics: Specialists Report Top Challenges (Greenway Health)
• Post Go-Live Stabilization: 4 Challenges and Tips for Success (Hayes Management Consulting)
• Complex, Inefficient Workflows are a Cyberattacker’s Best Friend (PatientSafe Solutions)
• CMS updates to MU Stage 3 and 2015 reporting (AdvancedMD)
• An Overview of California’s New Multi-Language Prescription Drug Labels Law (First Databank)
• Navigating the Sea of Innovation: Targeting the Right Audience with the Right Tools (AirStrip)
• 23 Disturbing Statistics about Mobile Security (AirWatch)
• Reducing Hospital Readmissions Through Medication Management (Besler Consulting)
• How Advanced Micro-Segmentation Can Reduce the Risk of Data Breaches (Burwood Group)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

Morning Headlines 10/20/15

Healthcare Vendors Agree To Interoperability Metric During KLAS Keystone Summit

12 EHR vendor executives met in Utah last week to establish a vendor-neutral set of metrics that KLAS will use to evaluate vendor interoperability performance moving forward. Participating EHR vendors included: Allscripts, athenahealth, Cerner, eClinicalWorks, Epic Systems, GE Healthcare, Greenway Health, Healthland, McKesson, Meditech, Medhost, and NextGen Healthcare.

Johns Hopkins and Microsoft Collaborate to Redesign Health Information Technology for the ICU

The Johns Hopkins University School of Medicine partners with Microsoft will co-develop an ICU surveillance system that integrates information from various medical devices and monitors for key trends and complications.

Technology Must Let Doctors Be Doctors

Athenahealth CEO Jonathan Bush pens an op-ed calling for a push to improve the user experience for doctors working in EHRs. The op-ed coincides with the launch of a new Athena-hosted public forum on the subject, and a Jay-Z inspired music video from ZDoggMD.

Digital Health Consumer Adoption: 2015

Rock Health publishes findings from its first survey on consumer adoption of digital health technologies, finding that less than 20 percent of the general public engages with any digital health tools beyond online searches for medical conditions and online doctor review sites. Interestingly, the survey found no correlation between adoption rates and age, gender, income, or education.

Morning Headlines 10/19/15

Hot Startup Theranos Dials Back Lab Tests at FDA’s Behest

The Wall Street Journal publishes a second piece on Theranos, this time reporting that the FDA views its “nanotainer,” a small capsule that it uses to collect samples, as an unapproved medical device. In response, Theranos quietly stopped using its finger-stick testing process on all but one test, and now instead uses traditional methods to collect and process the hundreds of other tests it offers.

SAP’s CEO gets personal in Palo Alto about his own recent health ordeal, delivers a call to action

During a visit to the company’s Palo Alto campus, SAP CEO Bill McDermott discusses a recent accident that left him blind in one eye, using the story to point out health IT inefficiencies he noticed from the perspective of a patient, explaining “In every single meeting, you have to repeat the entire story all over again, because there’s no one electronic medical record that comes before you — or follows you — throughout a case.” He calls the doctors who treated him amazing, though “unstructured in their behavior.”

Nordic accused of sexual harassment, retaliation

A local Madison, WI paper covers a sexual harassment complaint filed by the former Nordic VP of Marketing against the company president, Drew Madden. The complaint, which will be heard this week before the city’s Equal Opportunities Division, alleges that the former VP was “sexually harassed by her supervisor, the president and co-owner of Nordic, and then discharged in retaliation for reporting the harassment.”

Alberta Medical Record Breaches Hit ‘Epidemic’ Levels, Says Privacy Watchdog

In Canada,  Alberta’s Privacy Commission calls data breaches an epidemic after discovering that 48 employees at Calgary’s South Health Campus were inappropriately accessing a patient’s record.

Monday Morning Update 10/19/15

Top News

What seems like fall out from the Wall Street Journal’s exposé continues: Theranos ceases its trademark practice of collecting blood samples from finger pricks after the FDA raised questions about its “nanotainer,” the blood-sample tube company founder Elizabeth Holmes is so often depicted holding. The agency is looking into whether the container needs approval as a medical device, and the company has, as a result, stopped using it for most tests while it waits for approval. 

Last Week’s Most Interesting News

• Dell will acquire EMC for $67 billion.
• 23andMe raises $115 million in Series E financing.
• Verisk Analytics is rumored to have retained Morgan Stanley to sell its Verisk Health business in what should be a billion-dollar deal.
• Accenture predicts that the five-year cost of cyber attacks on US healthcare system will be $305 billion.

Webinars

None in the next few days. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Sentara Healthcare (VA) enters into an investment partnership with informatics vendor Medstreaming via the 12-hospital system and health plan’s Third Core investment group. Medstreaming will use the financing to ramp up its clinical data management system. Sentara Healthcare SVP Kenneth Krakaur and CFO Robert Broermann will join the Medstreaming board.

Announcements and Implementations

Geisinger Health System (PA) implements Cerner’s HealtheIntent population health management platform.

BluePrint Healthcare IT launches two mobile Care Navigator patient engagement packages for pediatric hospitals.

Billian’s HealthData expands its public data offering to include over 875,000 profiles of provider organizations.

Noble Health Alliance – a collaboration between Pennsylvania-based Aria Health System, Crozer-Keystone Health System, and the Einstein Healthcare Network – joins the HealthShare Exchange of Southeastern Pennsylvania HIE.

Urgent care software and services business Practice Velocity announces that all customer ICD-10 claims have been successfully processed.

Talksoft offers a mobile survey tool to benchmark patient experience and practice performance.

Security and Privacy

North Carolina’s Dept. of Health and Human Services notifies over 1,600 Medicaid patients of an August 19 security breach – an email sent without proper encryption – that may have exposed private health information. Thus far, there has been no sign of nefarious third-party interception.

An Alberta Privacy Commission spokesperson compares the province’s spate of EHR breaches to an “epidemic” after 48 employees at South Health Campus in Calgary inappropriately access a patient’s information. The incident, in which all of the staffers took a look at data on a mother taken into medical custody after the suspicious death of her daughter, follows numerous breach investigations including a conviction for improper access, two charges for the same crime, and the firing of an Alberta Children’s Hospital employee who inappropriately accessed the EHR to snoop into the PHI of nearly 250 people.

Technology

EClinicalWorks launches 10e, a cloud services platform incorporating EHR functionality with population health and patient engagement tools. In addition, the company offers all hospital system clients free interoperability of CDA data using a query-based exchange with Cerner, Epic, McKesson, Meditech, and Siemens.

Healow, an EClinicalWorks subsidiary, launches an IoT cloud, enabling third-party hardware and app developers to collect, store, and analyze patient-shared data through its API. 

Other

SAP CEO Bill McDermott addresses the need for more mobile and personalized health data analytics at a company event in Palo Alto, emphasizing the lack of both during his treatment for loss of an eye as the result of an in-home accident:

“In every single meeting, you have to repeat the entire story all over again, because there’s no one electronic medical record that comes before you — or follows you — throughout a case. In my case, I had serious eye injury as probably the primary challenge. And when you work with somebody who’s the retina specialist and something goes wrong with the cornea, you don’t even realize it as a patient, but that’s a whole new medical professional now that has to come into the equation. And then, if something goes wrong with the iris, that’s another medical professional. And then we can go to the lens, so before you’re too far along the process now, you’ve met with five different teams on one eye. It’s not that it’s too many, it’s just that the choreography and the collaboration between individuals is just not there. The system is not organized that way. [I] do think that it’s time for a new architecture, a new approach to managing not just the structured, but also the unstructured information.”

Sponsor Updates

• Experian Health will exhibit at HFMA Eastern Michigan October 19-20 in Plymouth.
• Impact Advisors publishes a new white paper, “Summary and Analysis of the MU Final Rule: Modifications in 2015-17 and Stage 3 Requirements.”
• PatientKeeper will exhibit at HFMA’s Revenue Cycle Conference/MAP Event October 25-27 in Fort Lauderdale, FL.
• PDS celebrates the official reopening of its new corporate headquarters.
• PerfectServe will exhibit at the Western Section AUA Annual Meeting October 25-29 in Indian Wells, CA.
• Sagacious Consultants will exhibit at the Central & Southern Ohio Chapter of HIMSS 2015 Fall Conference October 23 in Dayton.
• The SSI Group will exhibit at the 11^th Annual National Association of Healthcare Access Management October 19-20 in Mahwah, NJ.
• Surescripts will exhibit at the Healthcare Innovation Expo 2015 October 22 in Washington, DC.
• TeleTracking will exhibit at the Pennsylvania Organization of Nurse Leaders Conference October 21-22 in Gettysburg, PA.
• Valence Health will exhibit at the AMGA Institute for Quality Leadership October 20-23 in National Harbor, MD.
• Verisk Health staff participate in the second annual Verisk Community Service Week.
• Kalispell Regional Health shares its ICD-10 success story using VitalWare’s VitalAuditor.
• Huron Consulting Group will host Case Management: Navigating the Current Healthcare System Conference October 25-29 in New Orleans.
• Wellsoft will exhibit at ACEP 15 October 26-28 in Boston.
• XG Health Chair Glen Steele, MD will speak at the 6^th Annual Galien Forum October 27 in New York City.

Blog Posts

• Top 10 Hospitals Where Patients Prosper (Billian’s HealthData)
• Designing Clinical Communications – Part 1 (PatientSafe Solutions)
• After ICD-10: Plotting Your Department’s Next Big Win (Patientco)
• At This Pivotal Moment in Healthcare (Lexmark)
• Better Communications Between Physicians and Healthcare Organizations can Improve Outcomes (Phynd Technologies)
• The Worm in the Apple (PMD)
• “It Turned us Into Data Entry Clerks!” (Qpid Health)
• Using Non-Clinical Data Can Increase Impact of Analytics (Streamline Health)
• Cerner Domain Compare: Summit Team Brings InSync Awareness to Kansas City (Summit Healthcare)
• Sunquest Value of the Month: Flawless Execution (Sunquest Information Systems)
• RTLS – The ‘Chocolate’ that Energizes Your EMR (Versus)
• Introducing Voalte Platform! (Voalte)
• Traditional Healthcare BPO Sourcing Will be Tested as Never Before (Xerox)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

Morning Headlines 10/16/15

Cyberattacks Will Cost U.S. Health Systems $305 Billion Over Five Years, Accenture Forecasts

Accenture publishes a report predicting that the five-year cost of cyber attacks on US healthcare system will be $305 billion, resulting in six million cases of medical identity theft.

Statement from Theranos

Theranos responds to a critical story published in the Wall Street Journal this week that claims Theranos only processes 15 of the 240 tests it offers on its own instruments, while the rest are performed with industry standard lab analyzers.

Cheap Solar Comes to Wisconsin

Epic is profiled by a local paper for having the largest solar energy system in Wisconsin, bringing 2.2 megawats of energy to the Verona campus.

DrFirst Secures $25 Million in Financing from Goldman Sachs

E-prescribing vendor DrFirst closes $25 million in equity financing from Goldman Sachs.

News 10/16/15

Top News

Personal genome testing vendor 23andMe raises a $115 million Series E on a $1.1 billion valuation. The company nearly shut down in 2013 after the FDA shut down its direct-to-consumer sales and marketing efforts, but has pivoted and now generates its revenue supporting drug discovery. Lt. Dan takes a closer look on HIStalk Connect.

HIStalk Announcements and Requests

This week on HIStalk Connect: Philips partners with Amazon to bring HIPAA-compliant IoT connectivity to its population health platform. Microsoft co-founder Paul Allen invests $500 million in artificial intelligence research. Berlin-based reproductive health app Clue raises a $7 million Series A to grow its user base and expand functionality within its app.

This week on HIStalk Practice: MGMA15 updates from Sunday, Monday, and Tuesday. AdvancedMD launches new interoperability and benchmarking tools. AMA’s new Telehealth Services Group convenes to discuss expanding CPT codes. Heart and Vascular Center of Lake County goes with Allscripts for chronic-care management. AAFP takes ONC to task for its weak interoperability roadmap. Primary care and mental health clinicians discover integrating data can be painful.

Webinars

None in the next few days. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Glytec’s patent for its mobile diabetes management app, which offers patients real-time insulin-dosing guidance, receives approval from the US Patent and Trademark Office . 

DrFirst firms up $25 million in equity financing from Goldman Sachs, bringing its total financing over the last year to $42 million. The company announced last week the integration of its medication management software and secure communications with the Rx30 Pharmacy Management System.

Sunnyvale, CA-based Health Gorilla secures a $2.4 million Series A led by Data Collective. The company has also expanded its diagnostic test automation platform to include electronic ordering and secure messaging.

Theranos fires back after the Wall Street Journal publishes an exposé-like piece by Pulitzer prize-winning investigative journalist John Carreyrou highlighting the fact that company uses its proprietary testing equipment on only 15 of the 200-plus tests it performs, and that many of those tests require large samples rather than the “few drops of blood” the company claims. Theranos asserts that, “Stories like this come along when you threaten to change things, seeded by entrenched interests that will do anything to prevent change, but in the end nothing will deter us from making our tests the best and of the highest integrity for the people we serve, and continuing to fight for transformative change in health care.”

Sales

Seattle Children’s Hospital signs a three-year contract with Wellcentive to implement its population health management and value-based care solutions. The hospital will use the tools within its Seattle Children’s Care Network and Pediatric Partners in Care program.

Steward Health Care System (MA) moves forward with Meditech 6.1. Implementation across its nine hospitals is slated to begin next month, with a go-live date set for 2017.

Technology

Philips partners with Nuance to offer Nuance PowerScribe 360 users the ability to import radiology dosimetry data from its DoseWise Portal.

Medhost implements ExtraHop’s wire data analytics platform to gain insight into how providers use and experience its software. It’s also signed up for the Seattle-based company’s HL7 analytics to improve the troubleshooting process when HL7 interface problems crop up.

People

Validic Chief Marketing Officer Chris Edwards wins the CMO Growth Award from The CMO Club.

Pam Stampen (American Family Insurance) joins Nordic as vice president of human resources.

Eric Topol, MD (Scripps) joins the MyoKardio Board of Directors, and becomes chair of its science and technology committee.

Hackensack University Medical Center (NJ) Vice President and CIO Shafiq Rab, MD receives CHIME’s 2015 Innovator of the Year award.

Miles Snowden, MD (TeamHealth) and Linde Wilson (L.E.K. Consulting) join the Oxehealth advisory board.

Announcements and Implementations

LBJ Tropical Medical Center and 17 outpatient clinics in American Samoa go live on Medsphere’s OpenVista EHR. Four more clinics will roll out the technology in the coming months. Providers in the unincorporated US territory are eligible for Meaningful Use, and are in the process of qualifying for Stage 1.

Hospice Buffalo (NY) implements e-prescribing technology and services from Delta Care Rx.

Baystate Health selects Kyruus ProviderMatch software to streamline and standardize referral processes across its integrated network in Springfield, MA.

Holy Family Memorial (WI) rolls out telemedicine services via the Zipnosis platform. The vendor inked a deal with Michigan-based multispecialty provider group IHA earlier this month.

Mayo Clinic (MN) implements the Viewics Health Insighter analytics platform across several divisions within its Dept. of Laboratory Medicine and Pathology, including Mayo Medical Laboratories.

Government and Politics

The VA and Indian Health Service receive accreditation from EHNAC and DirectTrust, making them the first federal agencies to gain interoperability via the Direct exchange network.

Privacy and Security

Accenture reports that cyberattacks over the next five years will cost US health systems $305 billion in lifetime revenue. Adding insult to injury is the company’s estimate that one in 13 patients will have personal data stolen from technology systems within that same timeframe, leading 6 million people to become victims of medical identity theft. 

Innovation and Research

University of Wisconsin-Whitewater researchers determine that Hawaii, Wisconsin, and Iowa have the most efficient healthcare systems based on a five-year look at patient satisfaction scores and access trends, as well as financial and human resource data. The study, sponsored by the Wisconsin Hospital Association, was designed to give employers more insight into employee healthcare ROI across the country.

Other

The Georgia Partnership for Telehealth collaborates with Appling HealthCare System (GA) and WellCare Health Plans to open two new telemedicine-equipped health centers at schools in Appling County.

Epic’s “triple harvest” solar installation in Verona ranks as one of the largest in the area, with two arrays totaling 2.2 megawatts. The company grows alfalfa underneath its largest array, and has installed a network of 2,500 ground-source heat pumps under the alfalfa to heat and cool the campus. It’s somewhat ironic to compare the company’s attempts to go green with the impact its employment boom is taking on Madison’s public transportation system. Ridership on the city’s two routes to the Verona campus has increased by more than 25 percent annually since 2012. The company kicked in $26,000 to help run an extra route starting last month.

Sponsor Updates

•  Intelligent Medical Objects and Navicure will exhibit at the EClinicalWorks 2015 National Conference October 16-19 in Nashville.
• Leidos Health and Obix will exhibit at the Georgia HIMSS annual conference and tradeshow October 23 in Atlanta.
• Liaison Technologies covers 100 percent of health insurance premiums for its US-based employees and their dependents.
• LifeImage highlights the latest in image-sharing solutions at the 2015 Cerner health conference this week.
• Medecision Senior Clinical Content Specialist Lois Morris shares her most memorable case manager story.
• Netsmart will exhibit at the Providers Council Conference October 19 in Boston.
• Xerox will exhibit at the Midwest Fall Technology Conference October 25-26 in Detroit.

Blog Posts

• Horcruxes in Healthcare: Who Owns Your Medical Identity? (ID Experts)
• Endless Health IT Capabilities (Impact Advisors)
• Unless We Care a Whole Awful Lot (MedData)
• Epic MyChart patient engagement strategies: Buy-in, special challenges and Meaningful Use (Nordic)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

EPtalk by Dr. Jayne 10/15/15

Both the American Hospital Association and the American Academy of Family Physicians have publicly weighed in on ONC’s revised Interoperability Roadmap. Both organizations believe it doesn’t go far enough or fast enough.

Although quite a few stakeholders accuse the EHR vendors of being the villains with regards to data blocking, my personal experience has been that health systems and hospital-controlled physician networks are really behind it. Not to mention that ACOs naturally create barriers to interoperability as they encourage physicians to keep patients within a well-defined (often narrowly so) network.

I had the adventure of standing up a private HIE seven or eight years ago. The sponsoring health system’s express purpose was to share data only within our referral network. Providers affiliated with other hospitals were not invited to join.

At least in my metropolitan area, I haven’t seen that philosophy change across the years. While the AAFP calls for “increased accountability on industry and decreased accountability on those who are using their inadequate products,” I think we need to focus the microscope on some of the other interested parties.

Let’s hold health systems accountable. When their vendors provide interoperable products, they need to be using them in an interoperable fashion. They need to force their owned hospitals and employed physicians to accept and integrate electronic health data brought by patients. And they need to release the data electronically when patients request it. Mr. H’s story of his inability to get his records electronically is just one of thousands out there.

Let’s also bring the non-provider technology stakeholders into the business of being regulated in the same way that providers and hospitals are. For example, reference laboratories. The fact that there are still numerous laboratories who cannot (or will not) send LOINC codes with their results is appalling.

Let’s also start regulating the pharmacies, getting their information systems under control. One of my local pharmacies sends scads of duplicate prescription refill requests all the time. This leads our practice to have to spend time determining if they’re really duplicates or not. When we call the pharmacy to complain, we’re told that it happens due to limitations in their computer systems and the inability to match refill responses to the original requests in an accurate manner.

Since all patients and physicians depend on pharmacies and labs, why shouldn’t this be part of the solution? What about standardizing all the other systems we have to interact with, such as home health systems and those used by nursing homes and other extended care facilities? Many patients that we used to hospitalize for care are instead receiving services through home health agencies. It doesn’t do me much good to interoperate with the hospital if the patients aren’t in it.

I started reading the Roadmap essentially to have a break from reading the Meaningful Use final rules. I’ve been jumping around in it rather than reading it through, however. I was pleased that they called out “Authentication and Identity Proofing” early in the paper (page 11 if you’re interested). They admit that lack of standard approaches has hampered information sharing. They mention that Direct was intended to “work much like email and lower the barrier to exchange for providers and hospitals.”

In my market, however, Direct has added all kinds of confusion, especially for providers like me who have multiple practice situations. I have different addresses for the different urgent care groups I work with on different EHR platforms. If a PCP is looking for me to send a follow-up, how do they know where to send it? Other health organizations have created additional complexity. One organization created separate addresses for each location for each provider, so a cardiologist who sees patients at six physical locations has six addresses. Although I understand their original reasoning for doing it, it’s untenable in reality.

Page 36 addresses individual data matching. They point out that although HIPAA required creation of national identifiers for patients in 1996 and Congress blocked appropriations, there is no prohibition against private or non-HHS governmental agencies creating their own. They note that the Department of Veterans Affairs and the Department of Defense assign unique identifiers for service members. Although I understand the arguments against it, I’d volunteer to test drive a national ID myself even if it’s private and voluntary.

I’ve had too many bad experiences with using existing primary data elements (name, DOB, sex, phone number), both personally and professionally. Even existing non-healthcare governmental systems don’t always handle the data in the same manner.

Here’s an example. Due to my southern roots, my actual legal name has a compound first name. My legal middle name is actually a family name, which looks like a last name to most people. Then I have my actual last name. Let’s work with “Peggy Sue Herrington Mitchell” as our example. My original birth certificate was completed on a typewriter, with “Sue” landing squarely on the line between the caption for “first” and “middle” names.

When I was in medical school, I had to get a certified copy of my birth certificate to prove identity for licensure. My birth county had computerized, and the person keying the data had made “Peggy” my first name and “Sue Herrington” as my middle name. It also truncated the “Herrington” by a few letters since there weren’t enough characters in the middle name field. With the layout and truncation issues, the computerized copy didn’t match my college transcript or my medical school transcript or my passport, which had my legal name listed correctly. The authorities refused to accept my identity proofing. I had to petition the county to pull a microfiche copy of the original and certify it.

When I complained about the truncation issue as the reason for needing the original, they said that they were limited by their systems. I pointed out that it was good that George Herbert Walker Bush wasn’t born in my county because his middle names wouldn’t have fit either. The county clerk didn’t find that amusing.

Fast forward a number of years to last year when I applied for TSA PreCheck status. Guess what? TSA in 2014 had surprising character issues. I was told that if I wanted to continue through the application process, I needed to formally shift Sue into my middle name or they couldn’t process my application since “space” was considered a special character and wasn’t allowable in the first name field and they couldn’t run PeggySue all together because it wouldn’t match my passport. This meant changing my name on all my frequent flyer profiles.

Additionally I’ve had hundreds of issues with patient matching during system migrations and data cleanups, not to mention the HIE project. How many people with either longer names or those that are more complex than mine will look like different people depending on how the data was entered? Of course there will be other matching criteria, but it’s going to take a lot of work to meet their stated goals of reducing system duplicate record rates from 2 percent in 2017 to 0.5 percent in 2020 and 0.01 percent in 2024. It should be interesting to see where already strapped (or cheap, as the case may be) organizations find the resources to get it all done.

I still have more to read, but at least it’s more interesting than MU rules. What’s your take on the Interoperability Roadmap? Email me.

Email Dr. Jayne.

Morning Headlines 10/15/15

How Jeb Bush’s health plan overhauls IT: 5 things to know

Jeb Bush, cousin of Athenahealth CEO Jonathan Bush, publishes his alternative to Obamacare this week, calling for an end to the Meaningful Use program, or as the proposal states “eliminating government mandates and penalties for healthcare providers who do not use government-approved electronic health records."

Statewide Patient Engagement Campaign Underway

Louisiana launches a statewide patient engagement campaign to teach its residents about the health IT tools at their disposal, such as patient portals and the state’s HIE.

AAFP Letter To Karen DeSalvo, MD

The American Academy of Family Physicians argues that ONC’s recent Interoperability Roadmap is not aggressive enough and fails to hold parties accountable for future delays or failures, noting “The AAFP helped create a standard for the exchange of clinical summaries in 2007 – the Continuity of Care Record. Eight years and billions of dollars later, our members and their practices continue to experience the dismal failure with the current certified EHR technology in supporting clinical summary exchange.”

23andMe Raises $115 Million in Series E Financing Led by Fidelity Management & Research Company

Personal genome testing vendor 23andMe raises a $115 million Series E on a $1.1 billion valuation. 23andMe nearly shut down in 2013, after the FDA shut its direct-to-consumer sales and marketing efforts down, but the company has pivoted and now generates its revenue supporting drug discovery.

Morning Headlines 10/14/15

Verisk Analytics hires Morgan Stanley to sell healthcare business

Morgan Stanley has been hired to sell the healthcare division of Verisk Analytics, a deal that is projected to be worth between $900 million and $1.1 billion.

GPs’ diagnostic skills could be obsolete within 20 years’ time, says Hunt

In the UK, health secretary Jeremy Hunt predicts that within 20 years computers will be used to diagnose conditions rather than doctors, pledging to ensure the NHS is ready when this technology becomes available.

Trends & Insights in Ambulatory EHR

Peer60 publishes a report on the ambulatory EHR market. Epic and Cerner are leading in both market share and mindshare. NextGen holds a strong market share but virtually no mindshare among independent providers and, similarly, Meditech has a strong market share but virtually no mindshare among hospital-owned facilities.

Xerox Provides Update on Government Healthcare Business Strategy

Xerox will walk away from the failed implementations of its Health Enterprise Medicaid platform in California and Montana, writing off $385 million, or $0.22 cents per share, on its third quarter results.

News 10/14/15

Top News

Verisk Analytics is rumored to have retained Morgan Stanley to sell its Verisk Health business in what should be a billion-dollar deal.

Reader Comments

From Laura: “Re: EHRs. Thanks for highlighting that the problems with EHRs aren’t (just) design and usability. They also relate to the major new spate of inane and arcane, bureaucratic, insane regs and new rules that keep HIT tools from being efficient (or even sufficient). If we could cut loose all of Meaningful Use and all E&M codes, we could open new modes of treatment and care and improve everywhere.” Laura is an informatics-certified physician and professor. I suggest this exercise for those who blame their EHR for excessive clicks and documentation collection. Make a list of every piece of information the EHR requires to inboard and treat a new patient, then map it back to who demands or uses that data element. I’m pretty sure EHR vendors aren’t just adding required fields for their personal enjoyment – the provider has agreed to collect that information for some approved purpose, internal or external, most likely as a condition of getting paid. Usability factors aren’t all that important when your users, by the nature of their jobs, are required several times each day to enter the same 200 codified data elements on the the same screen for each new patient. Clinical employees of EHR vendors dream of a fantasy world in which their products are designed strictly for doctors, nurses, and patients. In the mean time, blaming the vendor for operationalizing the sad current state of healthcare is like blaming fast food restaurants for obesity – those who created the market demand refuse to accept responsibility and instead complain about those they pay to supply their needs.

HIStalk Announcements and Requests

Jenn is filing daily reports from the MGMA conference in Nashville. Want to know how ICD-10 turned out for practices or what’s being discussed in the exhibit hall? Check out her recaps from Sunday and Monday.

Ms. Byrd-Johnson sent photos of her Alabama class using the 10 Android tablets we purchased via the DonorsChoose project. The school district implemented a “bring your own device” policy and we bought the tablets for students who don’t have a device to bring. Also checking in was Mrs. Clark from Tennessee, whose students used the STEM kit we provided to study engineering design and then collaborate to design, discuss, and improve their projects.

Good or bad, the conference season is back. People are endlessly live-tweeting quotes from anyone with a PowerPoint behind them. I don’t get anything (except annoyed) from reading out-of-context, 140-character quotes pulled randomly by tweet-seekers compensated either by ego strokes or paychecks. I’ll be interested to see how conferences handle Periscope and other live video apps whose tech-obsessed users stream low-quality video from presentations and exhibit halls.

I’m also always reminded at this time of year at just how some healthcare people seem to spend every free minute attending conferences at the expense of their employers (and thus patients), reminding me of undergraduates who embrace the undemanding college life so much that they just hang around taking classes forever courtesy of their indulgent parents. I’m also amused that attendees flock to conferences devoted to mobile and tele-anything services, apparently not appreciating the irony of traveling great distances to physically watch someone talking about the huge benefits driven by online collaboration.

Welcome to new HIStalk Platinum Sponsor Clinical Computer Systems, which offers the Obix perinatal data system. The employee-owned, Elgin, IL-based company, which was founded in 1997, has been a labor and delivery technology leader, earning 10 consecutive KLAS rankings. It’s a CommonWell member, a member of the Allscripts developer program, and an Epic collaborator. Obix offers charting modules for intrapartum, recovery, post-partum, strip annotations, care plans, newborn, SCN, and remote provider access. It provides clinical decision support for fetal heart rate assessment and monitoring with automatic charting into the intrapartum charting module. Obix is certified as an EHR module and its products are approved as medical devices by the FDA. Thanks to Clinical Computer Systems for supporting HIStalk.

I found this Obix overview video on YouTube.

Webinars

None in the next few days. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

IT solutions provider UST Global makes a $5 million stock investment in Sandlot Solutions.

I mentioned this weekend that Dell was rumored to be acquiring EMC. The deal was announced Monday, with Dell paying $67 billion for the storage vendor, a 28 percent premium to the share price before word of the acquisition leaked out. Dell will take on another $50 billion in debt and use its VMware equity to finance the deal as it anxiously tries to find something to sell other than low-demand commodity PCs. EMC is lucky that someone with access to capital also is in a business that makes enterprise storage look sexy.

Xerox announces that it has decided not to complete implementation of its overdue Health Enterprise Medicaid processing systems in California and Montana and will write off $385 million in settlement costs in Q3.

Sales

In the UK, University Hospital of South Manchester NHS Foundation Trust chooses Allscripts Sunrise.

People

XG Health Solutions names Mike Bertrand (HealthWyse) as SVP of EHR application development.

ZeOmega hires Chris Brown (Cardinal Health Specialty Solutions) as SVP of sales and marketing.

University of Vermont Health Network promotes CMIO and interim CIO Adam Buckley, MD to the permanent CIO position.

Divurgent promotes Paul Anderson to VP of advisory services.

Announcements and Implementations

Two hospitals of Centegra (IL) go live on T-System’s EV EDIS, with Centegra-McHenry’s LWBS (left without being seen) count dropping to zero on go-live day.

AdvancedMD announces new benchmarking and interoperability solutions at MGMA, where the company is also highlighting its patient engagement and iOS-powered point-of-care solution.

Voalte announces Voalte Platform, which includes collaboration, management, analytics, and integration solutions.

Technology

British Health Secretary Jeremy Hunt says that computers rather than physicians will diagnose medical conditions within 20 years, adding, “You can get 300,000 biomarkers from a single drop of blood, so why would you depend on a human brain to calculate what that means when a computer can do it for you? I think it’s really important that we’re ready in the NHS to harness the power of data to give us more accurate diagnoses, in particular with that example.”

Other

A study finds minimal improvement from the Choosing Wisely program that addresses unnecessary tests and procedures. The authors conclude that the program needs a wider rollout.

Farzad Mostashari, MD tweeted out this photo of a page from Saving Gotham, a just-released book by former NYC Health Commissioner Tom Farley, MD, MPH that describes the public health efforts by former Mayor Michael Bloomberg and former NYHHC Commissioner Tom Frieden, MD, MPH (now CDC director). It sounds like a great read as the rest of the country starts catching on that there’s no such thing as health without public health no matter what intervention-obsessed hospitals and doctors would have you believe.

Peer60’s new standalone ambulatory facility EHR report (not ambulatory EHRs in general as other sites misinterpreted) finds that Epic and Cerner are tied for mind share leadership, with Epic holding a big market share lead. Meditech and Allscripts have decent market share in hospital-owned facilities, but zero mind share, meaning their customers are at risk for defecting. NextGen is also at risk since it has the highest market share among independently owned facilities, but also zero mind share in which Cerner, Epic, and eClinicalWorks dominate. Respondents said vendors should make their product easier to use, improve reporting, and improve practice management capabilities, although 32 percent say it won’t matter since the hospital dictates the EHR used.

The Kansas City paper covers Neal Patterson’s address at the Cerner Health Conference. He called on Epic to join CommonWell’s “open architecture” and announced that Epic-using Geisinger Health System will implement Cerner’s HealtheIntent population health management system. Karen DeSalvo looks like she’s passing Neal a happy stuffed bear in the photo.

Texting-obsessed teens are like compulsive gamblers who can’t stop even as they miss sleep, lose their attention spans, and lie about the time they spend texting, a new study finds. It recommends that parents set screen-free times, which doesn’t give me a lot of hope since many adults are just as phone-zombified as their kids. One opiate of the masses was probably enough.

Weird News Andy finds this story “selfieish,” in which selfie-obsessed millennials, convinced that they are celebrities basking in the exhilarating glow of their own limelight, are flocking to “the shallow end of the value pool” in trying to look better and market themselves more effectively by having plastic surgery.

Sponsor Updates

• AirStrip will exhibit at the HMA CEO Forum October 14-18 in Deer Valley, Utah.
• Aprima will exhibit at the Oklahoma Primary Care Association event October 14-16 in Oklahoma City.
• Wellsoft will exhibit at ACEP15 in Boston October 26-28.
• Hospital Sisters Health System writes about their reduction in medication alert fatigue using First Databank’s AlertSpace in Patient Safety & Quality Healthcare.
• Cardiopulmonary Corp. (Bernoulli) will host a focus group session October 16 during the CHIME15 Fall CIO Forum October 14-17 in Orlando.
• Bottomline Technologies will exhibit at Health Informatics New Zealand October 19-22 in South Island.
• PatientKeeper will exhibit at Becker’s ASC 22nd Annual Meeting in Chicago October 22-23 and will sponsor HFMA’s Revenue Cycle Conference in Fort Lauderdale October 25-27.
• CapsuleTech will exhibit at Salon Infirmier October 14-16 in Paris.
• HealthLoop Chairman Jordan Shlain, MD will present at London Business School’s Driving Innovation in Healthcare Delivery on October 20.
• Culbert Healthcare Solutions will partner with ConnexaHealth for consulting.
• Verisk Health and ZeOmega will exhibit at AHIP’s National Conference on Medicare and Medicaid & Dual Eligibles Summit October 18-22 in Washington, DC.
• Huron Consulting hosts a Coverage Analysis & Billing Compliance Workshop October 16 in Washington, DC. 
• EClinicalWorks will exhibit at The National Conference on Correctional Healthcare October 17-21 in Dallas.
• Fujifilm Medical Systems will exhibit at the Annual Scientific Meeting of the ACG October 16-21 in Honolulu.

Blog Posts

• Aventura and Brian Madden Talk Virtualization in Healthcare (Aventura)
• Preserving Appeal Rights on Your Cost Report (Besler Consulting)
• How New Technologies are Expanding Care (Billian’s HealthData)
• Designing Clinical Communications – Part 1 (PatientSafe Solutions)
• Big Data? How About Right-Sized Data? (Forward Health Group)
• Four Steps to Make Population Health Analytics Actionable (Caradigm)
• #IHeartHIT – Proactive Continuity of Care with ChartMaxx (ChartMaxx)
• Leading with Passion: There’s No Button for That (T-System)
• A Growing Trend: Centralized Referral Management (TeleTracking)
• 7 Facts About Cyber Security and Phishing (TransUnion)
• How can UltraLinq Help with Mobile Imaging? (UltraLinq)
• Strategic Thinking. (Voalte)
• Opioid Addiction: A Prescription for Disaster (Xerox)
• Predictive modeling and the elusive 1-2 percent (ZirMed)
• HIT Hiring Managers Want 70% Technical and 30% Traits (Direct Consulting Associates)
• Final Ruling is in … Meaningful Use 3 is Upon Us (Divurgent)
• Why I Love Health IT (Extension Healthcare)
• Final Meaningful Use ruling has arrived! What stays and what goes? (Galen Healthcare Solutions)
• ICD-10 Applying Lessons from Implementation (Greenway Health)
• A Shift to Service Lines in Hospital Service Delivery (Hayes Management Consulting)
• McKesson Horizon: Why Way Now? Part 3 (The HCI Group)
• How Will the Final Rules for Meaningful Use Impact You? (HDS)
• 6 Steps to Building Your Own Plain-Language Glossary (Healthwise)

The following HIStalk sponsors are exhibiting at the Cerner Health Conference October 11-14 in Kansas City, MO:

• Access
• AirWatch
• CoverMyMeds
• Crossings Healthcare Solutions
• Divurgent
• Elsevier
• Experian Health/Passport
• Fujitsu
• Zynx Health
• GE Healthcare
• Healthwise
• Imprivata
• Intelligent Medical Objects
• Leidos Health
• Lexmark Healthcare
• LifeImage
• MedCPU
• Merge Healthcare
• Nuance
• Summit Healthcare
• Surescripts
• The SSI Group
• Versus Technology
• VMware
• Wolters Kluwer

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

Curbside Consult with Dr. Jayne 10/12/15

All’s still relatively quiet on the ICD-10 front, so I’m catching up on other projects that have been pushed to the side during the transition. Most of my clients are seeing some sporadic claims issues, but nothing that is going to cause a major cash flow disruption. As long as practices have processes in place to monitor the revenue cycle and take action as soon as they see patterns forming, they should be fine, although it will take a good month to see how things are really working.

Some practices still haven’t sent a large volume of claims. I continue to be surprised when I see practices that don’t bill every night or don’t have requirements for their providers to complete charts in a timely manner. I don’t have a lot of visibility into how ICD-10 is going on the hospital space, so I look forward to hearing from readers.

I’m working on a lab project for a client. It’s the kind of project I enjoy – extremely detail-oriented, beneficial to end users and patients, but something that practices don’t seem to have time to deal with. Essentially it’s an analysis of their lab ordering patterns with an eye towards redoing their primary ordering screen and some order sets. The practice set up their orders when they went live on EHR in 2010 and haven’t touched it since. A lot has changed in the last five years. They’ve added vendors. Vendors have changed test codes. The community standard of care has changed. Professional organization recommendations have changed.

I’ve pulled all their ordering data and can manipulate it by provider, specialty, location, and time. Right now I’m working on the tedious (yet oddly satisfying) task of updating the vendor order codes to make sure they’re all correct. Luckily they’re using two national reference labs that were happy to provide me digital versions of their orders master. Unluckily, they’re also using a hospital lab where all the knowledgeable lab staff seem to be out of the office on an ongoing basis. They won’t give me their order master (citing “intellectual property”), so I’m at a bit of a disadvantage. I’m not sure how having a copy of the orders master is going to cause them harm since they have an online directory for providers to reference.

Their level of cooperation may also explain why the practice sends such a small portion of its business to the hospital lab. If their day-to-day service is anything like what I’ve experienced, I’d steer clear. One would think it was in their best interest to assist customers in cleaning up their orders, because every time they receive an invalid one, they have to call the office for a clarification. But I guess it’s like everything else with being short staffed. Additionally, I’m sure it didn’t occur to them to plan for the eventuality that if all their customers go to EHR, eventually they’re all going to have to update their orders masters. Interoperability seems like a great idea until you realize you don’t have the resources to support it.

Keeping vendor codes in sync can be a full-time job. Some of the national reference labs change codes as often as weekly. Some are better than others at telling you what codes have been retired or replaced. Others leave you guessing somewhat. I’m seeing some challenges, though, with the various vendors coming up with proprietary tests which can make it hard on the end users. Say a user wants to order a serum porcelain level (a common med school/residency joke). In many cases, the physician doesn’t care whether the test is run via liquid chromatography or liquid chromatography and mass spectrometry – they just want the value. For a large number of tests, the methodology doesn’t make that much of a difference.

Of course there are tests where it makes a tremendous difference and I would expect to see the methodology specified in the name of the test to make it clear. Labs, however, seem to be trademarking various methodologies – perhaps one calls it “PorcelainPure” and the other calls it “TruPorcelain.” It’s impossible for the end user to figure out what they’re ordering without going to websites and comparing. This becomes more of an issue when patients are switching insurance or employers (and therefore lab providers) and end up having serial tests done at different facilities. It’s also a problem when the tests really are equivalent but the labs have trademarked them as a marketing strategy. It’s getting to the point where we almost need generic and branded labs like we have for drugs. I’ve seen it become more complex even over the last two to three years, so I can’t imagine what the next decade will bring.

Once I get all the codes up to speed, I’ll provide them with a program to help keep the codes up to date. Usually I suggest monthly, but a lot of organizations aren’t staffed to keep up with that. They may elect to do it quarterly or twice a year. I stress that it should at least be done every six months or more often if the lab provides clear information on the nature of changes to its orders master. After that, I’ll start reviewing the data based on ordering patterns and we’ll really start doing some clinical transformation.

In midsize practices, it’s interesting to see how different providers order even when they share a specialty. I see a lot of variation in ordering of metabolic test panels. Some habitually order more comprehensive panels whether they’re indicated or not. There is also a lot of variation in cholesterol testing and pap testing. These are conditions where the indications are well identified in national recommendations and guidelines, so you can imagine what it looks like when we analyze ordering on less-common conditions and diagnostic workups.

There can be emotional minefields associated with analyzing ordering patterns. What do you do with your senior partner who is ordering tests based on outdated recommendations? Many groups are unwilling to deal with those kinds of issues head-on, so I end up creating educational programs where everyone in the group gets re-educated as to the current standard of care. Although it’s good to make sure everyone is following guidelines, it’s a tremendous waste of resources when everyone else is already in line and you could just deal with an individual directly.

There are a lot of people out there who never want to ruffle anyone’s feathers, which makes it easy to see why they’re having challenges delivering the kind of care they want to deliver and that patients expect. As the old saying goes, sometimes you have to break some eggs to make an omelet.

Once we analyze the ordering patterns, I’ll make suggestions on updates to the main orders screen and the order sets. We want to get the most commonly ordered tests in prime position for ease and speed of selection. There’s an art to it, though, because if you make too dramatic of changes, it can cause issues with muscle memory and the staff getting back up to speed.

We also have to figure out the timing and how we’ll train users, etc. There’s a lot more to it than just updating templates, and often my role is to help an IT team understand that. We need to give the users time to practice so they’re not hunting around when they’re patient-facing.

I’ll be working on this for a while, so I’m interested to hear how readers approach similar projects. Do you like your eggs over easy or sunny side up? Email me.

Email Dr. Jayne.